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ADVANCE Perspective: Physical Therapy & Rehab Medicine

Soccer Surges on the American Sports Scene
by Brian Ferrie

The explosive growth of interest in the world's most popular game -- soccer -- is perhaps the most striking development in American sporting culture over the past several years. In previous decades, as the rest of the globe worshipped the sport like a religion, the United States stubbornly held out as a nation that viewed soccer with relative apathy, fixating instead on football, baseball, basketball, and hockey.

But that tide is certainly changing, if not at the expense of those other sports, then at least in addition to them. In fact the latest ADVANCE cover story details the meteoric rise of Major League Soccer (MLS), now celebrating its 20th season with surging levels of attendance, interest, quality of play, and worldwide relevance.

What makes the enhanced interest in soccer nationwide even more fascinating is that unlike most traditional sports followed by Americans, soccer has generated significant fandom for both male and female competitions. On the men's side, in addition to the swelling popularity of MLS, the U.S. national team has clearly become a respected player on the global scene by qualifying for seven consecutive World Cups and advancing to the knockout round of the last two (2010 and 2014). Even non-soccer fans had to be impressed last summer by the fervent patriotism and enthusiasm accompanying game watches for the U.S. team at block parties and bars across the country, while the World Cup played out thousands of miles away in Brazil.

Meanwhile the U.S. women's team just routed Japan, 5-2, in their own World Cup final on July 5 to spectacularly earn the title of top female squad on the planet. That match also became the most-watched soccer game in United States history. Not just the most-watched women's game, but the most-watched game, period. Its 26.7 domestic viewers just edged out the 26.5 million who tuned in for last summer's epic World Cup men's final between Germany and Argentina.

So it's fair to say our great country is now truly recognizing what the rest of the world has long seen -- how captivating and uniting this remarkable sport can be. What do you think about soccer's surging significance in America? Have you become a more devoted fan over the past few years too? For readers who treat athletes, are you noticing more kids and adults these days who play soccer, male or female? Let us know!

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Physical Therapy at the DoD Warrior Games
by Dillon Stickle
From June 19-28, more than 240 wounded, ill, and injured service members and veterans from across the country gathered for the annual Department of Defense Warrior Games at Marine Corps Base Quantico, Virginia. Athletes represented teams from the Marine Corps, Army, Navy, Air Force and U.S. Special Operations Command. This was the first year the DoD organized the games, usually done by the United States Olympic Committee.

In his welcome letter, Major General Juan G. Ayala of the United States Marine Corps and Commander, Task Force at the Warrior Games said, "Since its inception in 2011, the DoD's Military Adaptive Sports Program has helped wounded, ill and injured Service members recover and rehabilitate for transition back into their military units or into civilian society. All of us in the Marine Corps, and across the DoD, are extremely proud to be part of an endeavor that is both beneficial and rewarding for our Nation's warriors."

According to the Department of Defense, "adaptive sports and athletic reconditioning activities play a fundamental role in recovery, rehabilitation and reintegration of service members back to their units, or as they transition into the civilian environment." Service members participated in games like wheelchair basketball, sitting volleyball, swimming, shooting, and track.

Team Army actually had a team of six physical therapists join them at the games, ensuring their safety, maintaining their health, and maximizing their performance. Army came out on top at the games, earning 162 total medals.

Did Army come out victorious because of their PT team? Do you think all the teams should have a group of therapists attend the games? Let us know in the comments!

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Developments at the NATA Annual Meeting
by Jon Bassett

"I shall not cry because it's over. I shall smile because it happened."

With a nod to Dr. Seuss, Jim Thornton, MA, ATC, CES, outgoing president of the National Athletic Trainers Association (NATA), put a stamp on his tenure at the "Changing of the Guard" ceremony during the NATA's 66th Annual Symposia and AT Expo, held in St. Louis June 24-27, 2015.

The NATA welcomes Scott Sailor, EdD, ATC, as incoming president for the next three years. Sailor, chair of the kinesiology department at Fresno State University, began his official tenure June 25.

"I'm very excited to become your 13th president," Sailor told the capacity ballroom crowd. "I believe we can accomplish amazing things. I do not take this responsibility lightly." He was elected in October 2014.

As objectives for his presidency, Sailor [pictured at right] specified ongoing misunderstandings among many policymakers surrounding what athletic trainers do, and the development of a strategic plan reflecting the modern needs and experiences of today's athletic trainer. In May 2015, the NATA's board of directors approved a mission statement and vision statement to guide the profession.

"Great opportunity lies before us," Sailor said. "I challenge each one of us to get involved." 

Position Statement on Spine Injury

In other conference news, the association released an executive summary of a new inter-association consensus statement on "Appropriate Care of the Spine-Injured Athlete." This is an update to the original 1998 consensus statement guidelines in light of recent changes in literature for pre-hospital treatment protocols and a discussion among task force and spine trauma researchers.

"These updated recommendations are critical to ensure proper and immediate care of the athlete and to reduce or prevent catastrophic outcomes," said task force chair and NATA Vice President MaryBeth Horodyski, EdD, ATC, FNATA. "The athletic trainer and other members of the sports medicine team must work together to ensure clear and immediate communication. Establishing an Emergency Action Plan for use and review by the sports medicine team is essential."

The 14-point plan, which covers immediate assessment, equipment removal, immobilization and transportation guidelines, is viewable at www.nata.org/access-read/public/consensus-statements. Also look for a full-length feature article by Horodyski in the July issue of ADVANCE.

Public Perception of Athletic Training

During J&J Day, a block of programming sponsored by Johnson & Johnson June 25, a four-member speaker panel discussed "A Patient-Centered Vision for the Future of the Athletic Training Profession." Audience members heard opinions on the way athletic trainers are viewed by patients, school administrators and politicians.

"We've got a very serious issue with the way the public perceives us," said Gary Wilkerson, EdD, ATC, professor at the University of Tennessee Chattanooga. "We've got to do more to make the public aware that we are health professionals."

Wilkerson still receives feedback that views the AT profession as "taping ankles, dispensing water, massage, and coaching." Athletic trainers must position themselves as separate from a team's coaching staff, and become the managers of the full spectrum of health needs for a specific population, said Wilkerson. He pointed to such differentiators as concussion management, cardiac issues, asthma and lifting and training technique to underscore the value of ATs as healthcare providers.

"We have to be the protectors of the welfare of our student-athletes," he said.

Athletic Training Moves to a Master's

Finally, the NATA held an open discussion with membership regarding the proposal to transition the athletic training profession to an entry-level master's degree. More information can be viewed at www.atstrategicalliance.org

 

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PT Day on Capitol Hill
by Brian Ferrie

The morning of June 4 started very early for more than 1,000 dedicated attendees at the American Physical Therapy Association's NEXT 2015 Conference & Exposition in National Harbor, Md. These hardy souls awoke before the sun, donned their professional best and headed downstairs by 6 a.m. for a quick breakfast before boarding shuttle buses bound for nearby Washington, D.C. The much-anticipated PT Day on Capitol Hill had arrived!

Despite the early hour, their energy and enthusiasm abounded. Led by Michael Matlack, APTA director of grassroots and political affairs, the attendees disembarked from their shuttle buses in front of the Capitol Building and paraded to a nearby lawn. The light drizzle couldn't dampen spirits as they anticipated their opportunity to march into the Capitol and talk with legislators about the pertinent issues impacting the PT profession.

A succession of speakers addressed the attendees while they waited until 9 a.m. to make their move. Among them was APTA Past President Paul A. Rockar Jr., PT, DPT, MS, who said, "Our goal today is to communicate the value and importance of physical therapy in healthcare, and the way that it transforms lives. I've learned a lot of lessons about advocacy over the years, and one of the most important is we can't take for granted that our role in educating legislators will be done by somebody else. We need to do it. From sharing with them the real-life patient stories about the harmful impact of the therapy cap, to reminding them about the vital role physical therapists play in treating concussions and our job as the number-one resource in physical therapy. We're all equally accountable in finding a role to ensure our success."

Rockar was followed at the podium by Rep. Xavier Becerra of California, an important ally of the profession who has co-sponsored HR 775. This bill, the "Medicare Access to Rehabilitation Services Act," would repeal the outpatient therapy cap.

Congressman Xavier Becerra, a member of the U.S. House of Representatives for California's 34th congressional district.

"I want you all to know that many members of Congress are with us on this," he told the audience. "Including my friend Rep. Charles Boustany from Louisiana, the principal co-sponsor along with me of HR 775, which will undo this fits and starts way of providing the best care to a lot of Americans who have paid for it under Medicare. We want to say thank you for their support. Shout out nice and loud so everybody in the Capitol Building over there can hear you, we're ready to make sure HR 775 becomes the law of the land!"

Finally, Matlack himself spoke, looking proudly out on the eager group he had played such a vital role in assembling.

"I want to share with you one of my favorite quotes when it comes to advocacy," he said. "These are the words of Thomas Jefferson: ‘We in America do not have government by the majority, we have government by the majority who participate.' You're participating, and I really appreciate that. All of you came to D.C. to do this. Now we need to tell our colleagues back home. Because it's not just one time you're here to advocate. You need to continue to do that. Today you're participating for your profession, patients and colleagues. Are you ready to share with your members of Congress and their staffs how physical therapy can provide the answers and savings for the healthcare system? Today is our opportunity to highlight the benefits of rehabilitation and the services we provide. Let's make history!"

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‘It's a Calling to Be a PT'
by Brian Ferrie

NATIONAL HARBOR, MD -- The APTA Annual Conference & Exposition, which was rebranded last year as "NEXT," just celebrated its 2015 incarnation in this inviting little town on the Potomac River outside Washington, D.C. The conference drew thousands of excited physical therapy professionals and advocates from all over the country, kicking off the night of June 3 with a memorable opening event.

Replicating last year's well-received format, APTA CFO Rob Batarla served as host of a "Tonight Show"-style presentation, in which APTA leaders gave their thoughts on the profession and entertained the crowd in a variety of ways.

The first guest was APTA CEO Michael Bowers, who was asked by Batarla to talk about the organization's goals. "I couldn't be more excited to be working with the members that we have," Bowers responded. "The focus of the APTA is to transform society, which can be a very large task. We have to make sure the profession is ready to do transformational work through education, research and practice."

Bowers was followed on stage by APTA Past President Paul A. Rockar Jr., PT, DPT, MS, and newly elected APTA President Sharon L. Dunn, PT, PhD, OCS, who both drew laughs from the audience by playing a lighthearted trivia game about Rockar's recently completed three-year term in office.

For the final question, "What does Paul Rockar most regret about his presidential tenure?" he earned cheers by saying, "I regret nothing, and I can't wait for Sharon to experience that same feeling."

But the highlight of the night was Keynote Speaker Billie Jean King, the legendary women's tennis player and social rights advocate who charmed the audience with tales of her playing career, and efforts to spread the cause of feminism both on and off the court.

"The thing about tennis, like soccer, is that it's really a global sport, which has given me a great opportunity to make a difference," she said.

King also paid tribute to the impact physical therapy has made on her.

"I've given you a lot of employment in my life," she said with a laugh. "You not only take care of us physically but you help with the emotional part too. It's a calling to be a PT. I don't think it's just a job. You're very special people, so give yourselves a pat on the back."

The night ended with a spectacle few will soon forget, as King took out a tennis racket while "Philadelphia Freedom" began playing through the speakers. Elton John actually wrote this song about King almost 40 years ago and named it after the tennis team she played for at the time. While delighted attendees danced to the popular tune and cheered the charismatic icon before them, King wound a path up and down the aisles, hitting souvenir tennis balls all around.

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Coming Up NEXT -- The 2015 APTA Annual Conference
by Brian Ferrie

As many ADVANCE readers are likely aware, the American Physical Therapy Association (APTA) last year rebranded its traditional "Annual Conference & Exposition" as simply "NEXT". The APTA website stated at the time, "It's a name change, but more than that it's a commitment to making APTA's June conference about looking into the future of physical therapy. ‘NEXT' isn't an abbreviation, but it does stand for something: It's a name thematic of where this conference and profession are headed."

From June 3-6, NEXT 2015 will be held in National Harbor, Md., a stone's throw away from Washington, D.C. According to APTA: "NEXT is the leading-edge event for physical therapy professionals with trend-setting programming, innovative content, and exclusive access to the profession's forward thinkers. This year NEXT coincides with PT Day on Capitol Hill, giving you the chance to rally on Washington with your peers and meet with your elected representatives."

PT Day on Capitol Hill is expected to include more than 1,000 physical therapists, physical therapist assistants, and students on June 4. Attendees will first rally by the Capitol before participating in scheduled meetings with their elected representatives in Congress, providing "a special opportunity to advocate for the physical therapy profession and the patients it serves!" exclaims the APTA website.

Aside from this signature event, NEXT will continue to offer hallmarks of previous annual conferences, including the 46th McMillan Lecture (presented by Lynn Snyder-Mackler, PT, ScD, ATC, SCS, FAPTA), and the 20th John H.P. Maley Lecture (offered by Gad Alon, PT, PhD). In addition, the popular Oxford Debate returns, with this year's topic "Mind Your Business" exploring whether all physical therapists should demonstrate comprehensive business management and marketing principles as an entry-level skill in all settings. Finally, the keynote speaker will be Billie Jean King, a Hall of Fame female tennis player who was named one of the "100 Most Important Americans of the 20th Century" by LIFE Magazine.

For prospective attendees unfamiliar with National Harbor, the location's official website offers this description: "Perched on the historic Potomac River, National Harbor is a unique, all-in-one destination and all-American tradition, offering unrivaled shopping, dining and attractions and a roster of year-round, family-friendly events. Featuring expansive views from the riverbank -- and from 180 feet up on The Capital Wheel, the waterfront's newest iconic draw -- National Harbor combines an approachable, resort-like personality with a singular, dynamic experience for local residents and visitors alike. With more than 10 million annual visitors, there's simply nowhere else on the Eastern Seaboard you'll find this mix of things to do, see and experience."

You can count on ADVANCE to be there covering all the action at NEXT, reporting on the sights and sounds of National Harbor, Capitol Hill and the APTA. Stay tuned to our Facebook page, Twitter handle, and of course traditional website for informative blog posts, quotes from influential leaders and insightful images. Will you be attending NEXT too? What are your hopes and expectations for the conference?

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Is Hotter Really Better?
by Dillon Stickle
Lately, it seems like everyone wants their exercise to be hot. Hot Pilates, hot lifting, hot spinning, and, easily the most popular currently, hot yoga (or Bikram). The more I read about it and the more good things I hear from friends and family, the more I am intrigued to try it. But, I also wonder: is doing a supposedly relaxing form of exercise in extreme heat with humidity really good for your physical health?

I came across an article in The Atlantic today called "The Enduring Appeal of Being Hot." It goes into how hot yoga has become so popular and what appeal exercising in heated conditions really has - a lot of people think it's all about how you feel mentally and emotionally, but some think it has physical benefits.

Many common goals of physical therapy can be assisted with implementing yoga into the patient's overall program: balance, flexibility, and alignment are just a few. But what would a physical therapist think about the practice of hot yoga? Does it have the same benefits? Does it help more? Maybe it actually goes against the purposes of yoga for physical therapy.

ADVANCE asks Lauren, who is a recent DPT graduate, what her opinion is on the matter. "Some [physical therapy] exercises are very similar to other forms of physical activity such as Pilates or yoga. Some physical therapists even choose to get furthering continuing education in these different realms, with physical evidence available for the physiological benefits of participating in yoga or other activities."

"Though," she continues, "at this time, there is very limited evidence on the benefits of hot yoga in particular. More research would need to be done in order to determine its physiological benefits."

Interestingly enough, everyone I have asked said that hot yoga makes them feel better both mentally and physically. Though when asked what particular physical benefits they feel are taking place, the answer becomes lost in translation.

ADVANCE readers, from a PT standpoint, do you feel that Bikram or hot yoga compared to normal yoga has any added benefit? If more evidence came out supporting hot yoga as its own form of therapy, would you recommend it to your clients? Do you have any personal experience with hot yoga or studies that suggest it may help? Let us know in the comments below!

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AOTA Looks Ahead
by Jon Bassett
NASHVILLE -- During her Presidential Address at the American Occupational Therapy Association's 95th Annual Conference & Expo, held April 16-18 in Nashville, AOTA President Virginia "Ginny" Stoffel, PhD, OT, BCMH, FAOTA, took stock of the current state of the profession and set a course for the decades ahead.

Stoffel is associate professor in the department of occupational science and technology at the University of Wisconsin-Milwaukee. The association's 29th president, she is currently in her second year of a three-year term.

The profession's numbers are growing rapidly, reported Stoffel. While a recent AOTA count placed the number of practicing OTs, OTAs and students at 140,000, more recent estimates place the count closer to 185,000. And according to the U.S. Bureau of Labor Statistics, by 2022, there will be a need for 29% more OTs and 43% more OTAs.

"We need to set 100,000 as our next membership target," said Stoffel in relation to the rising ranks of OT practitioners. "Can you imagine how much more we could accomplish." Stoffel acknowledged the commitment of OT professionals worldwide, having made 36 trips so far as president.

"Engagement strategies may well be one of our greatest strengths as a profession," said Stoffel.

And as 2017 approaches -- the 100-year anniversary of the profession -- AOTA must look beyond that milestone and set new objectives, said Stoffel. The association has retained a public relations and branding firm to craft a new vision statement, in addition to member feedback in the form of focus groups, and electronic surveys. The new vision will be unveiled at next year's conference in Chicago.

"It's time to update our vision for the profession, to look carefully and boldly toward the future," announced Stoffel. "I hope that our future holds a clear, lit path to empowerment as a core attitude of all occupational therapy practitioners."

View more coverage from AOTA here.

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Early PT Cost-Effective for Low-Back Pain
by Brian Ferrie

The American Physical Therapy Association (APTA), Alexandria, Va., issued a press release on April 9 detailing the results of a recent study published in the scientific journal BMC Health Services Research. The study demonstrated that early and guideline-adherent physical therapy following an initial episode of acute, non-specific low-back pain (LBP) resulted in substantially lower costs and reduced use of healthcare resources over a two-year period.

The press release continued: "Physical therapist researchers John D. Childs, PT, PhD, et al analyzed 122,723 patients who went to a primary care physician following an initial LBP episode and received physical therapy within 90 days. Of these, 24% (17,175) received early physical therapy (within 14 days) that adhered to guidelines for active treatment. During a two-year time period, these patients made significantly less use of advanced imaging, lumbar spinal injections, lumbar spine surgery, and opioids than did patients in other combinations of timing and adherence."

Early PT patients also had 60% lower LBP-related costs, compared with 33.5% (23,993) of patients who had delayed and adherent physical therapy (between 14 and 90 days). Patients received physical therapy within the Military Health System, one of the largest single-payer systems in the United States.

"Physical therapy as the starting point of care in your low-back pain episode can have significant positive implications," Childs explained. "Receiving physical therapy treatment that adheres to practice guidelines even furthers than benefit."

Clinical guideline recommendations in military and civilian settings are to avoid opioids and advanced imaging procedures as a first-line of treatment. However, research done mainly in civilian settings has revealed clinical practice is inconsistent with these recommendations. Childs noted that the study's results extend the findings from civilian settings by demonstrating an association between early guideline-adherent care, costs, and use of healthcare resources in a single-payer health system.

According to American Physical Therapy Association President Paul Rockar Jr., PT, DPT, MS, "Given the enormous burden of excessive and unnecessary treatment for patients with low-back pain, cost savings from physical therapy at the beginning of care has important implications for single-payer health care systems."

What are your thoughts about the findings of this study, and how do you think it may impact the public perception of physical therapy?

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Cutting-Edge Collaboration
by Brian Ferrie

PHILADELPHIA -- When the National Soccer Coaches Association of America (NSCAA) Annual Convention came to this country's birthplace last week, ADVANCE made sure to be on the scene. Held in conjunction with the 2015 Major League Soccer (MLS) draft, the conference is billed as "The World's Largest Annual Gathering of Soccer Coaches," drawing more than 10,000 attendees for live field demonstrations and lecture sessions.

The City of Brotherly Love played host to the 2015 National Soccer Coaches Association of America Convention.

This year for the first time, US Soccer and MLS also partnered to conduct a trailblazing two-day Medical Symposium during the convention. Featuring healthcare professionals from both organizations, it focused on player health and safety issues related to youth, amateur and professional soccer.

The event provided an opportunity for the soccer community to review the latest research, identify best practices, develop additional strategies for enhancing safety and reducing injuries, as well as chart a course to further understand soccer-related medical issues.

Of particular interest to ADVANCE was the session, "Lower Extremity Injuries in the Sport of Soccer," presented by John Gallucci Jr., MS, ATC, PT, DPT, president of JAG Physical Therapy in New Jersey and medical coordinator of Major League Soccer.

Also the former head trainer for the league's New York Red Bulls, Gallucci now coordinates the medical care of more than 500 professional soccer players in MLS.

"For this presentation, I've tried to take all my years of experience as a physical therapist and athletic trainer, to bring you the common-sense concepts of where we stand today in preventing and treating soccer injuries," Gallucci told the attentive audience. "Being dual-degreed, it's great that I can help athletes from the start of their injury all the way to returning to full participation."

He pointed out that soccer is among the fastest-growing team sports in the United States, with an estimated 15.5 million participants, and that 50-80 percent of all soccer injuries are to the lower extremity.

"You as coaches and administrators can be advocates for your injured players," emphasized Gallucci.

One of their most important roles is to enforce sensible practice schedules to help prevent overuse injuries, which are responsible for nearly half of all sports injuries to middle and high school students, he noted.

How do overuse injuries occur? "Too much, too often, too quickly, and with too little rest and recovery," said Gallucci. "Most overuse injuries can be avoided with common sense and good training programs."

Coaches need to understand the requirements of their athletes, which can vary based on sport, position, and level of competition.

"Every exercise is not appropriate for every athlete!" he added.

Speaker John Gallucci Jr., MS, ATC, PT, DPT, medical coordinator of Major League Soccer.

When soccer players do get injured, Gallucci stressed that coaches should be patient during rehabilitation and respect the process.

"To return to sport, an athlete must have no pain, range of motion within normal limits, 5/5 strength, ability to perform sport-specific drills in a clinical setting, and graded return-to-play progression," concluded Gallucci. "You can't take a player straight from a treatment session to a 90-minute game."

For more information about the 2015 NSCAA Annual Convention and US Soccer/Major League Soccer Medical Symposium, check out http://www.nscaa.com/.

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APTA Applauds Groundbreaking AARP Action
by Brian Ferrie

The American Physical Therapy Association (APTA), Alexandria, Va., issued a press release on Tuesday supporting a groundbreaking action taken last week by the American Association of Retired Persons (AARP). The APTA statement reads, in part:

"On Dec. 11, 2014, the AARP, in a letter of support addressed to Rep. Jackie Speier (D), became the first consumer organization to publicly endorse tightening restrictions on physician self-referral by eliminating the in-office ancillary services (IOAS) exception for four specific services, including physical therapy, under the Stark law. In a significant win for the U.S. healthcare system and the patients it serves, the 38-million-member AARP has thrown its considerable weight behind the legislation sponsored by Speier, commending her work to improve healthcare and reduce spending.

"The APTA wholeheartedly applauds AARP for this bold move. Removing these services from the IAOS exception would transform healthcare to save the country billions in unnecessary treatments and protect patients from being used as pawns for profit. The Stark law prohibits a physician from making referrals for certain Medicare health services to an entity with which he or she, or an immediate family member, has a financial relationship -- unless an exception applies. The IOAS exception is intended for the delivery of services that could be quickly administered for patient convenience, such as routine lab tests or X-rays.

"However, physicians' expansive use of the IOAS exception to include therapy services, in a manner outside the spirit of the law, undercuts the law's very purpose and substantially increases costs to the Medicare program and its beneficiaries. The Office of Management and Budget concluded that closing the loophole for these services would save just over $6 billion over the 10-year budget window, a number to which AARP directly referred in its letter of support."

APTA President Paul A. Rockar Jr., PT, DPT, MS, added, "APTA continues to urge Congress to take action to close this loophole, which threatens the integrity of the Medicare program. We'd like to see patients put back in the driver's seat, receiving treatment because they need it to be healthy, not because of the profit it will generate. It is time to take action. It is time for Congress to pass the Protecting Integrity in Medicare Act (PIMA) (H.R. 2914) and close the loophole. We are pleased to see AARP join the fight, and we stand behind them 100%."

The APTA has long viewed referral-for-profit as a hot-button issue, and in fact the organization is a founding member of the Alliance for Integrity in Medicare (AIM), a consortium of organizations that advocates for Congress to address the IOAS exception loophole.

However, some individual PT professionals might have different perspectives on the issue, including current employees of physician-owned physical therapy services (POPTS). What are your thoughts about referral-for-profit and the recent stance taken by AARP on the subject? Do you agree or disagree with the APTA's perspective?

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Errorless Learning for Memory Impairment
by Brian Ferrie

Post written by ADVANCE guest blogger Rachel Wynn, MS, CCC-SLP

Let's start with a story that takes place in a SNF where I worked. The tight quarters of a small therapy gym and rehab wing allowed for easy co-treating and observation of my fellow therapists' treatment, which I found incredibly valuable as a new graduate. I noticed when a very gentle occupational therapist worked with a patient (with memory and cognitive impairment) on training safe ADLs, she often corrected with "no," "don't do that," or "uh uh."

Despite the constant correction, this patient was continuing to make the same "mistakes" (or not complete targeted behavior). I had a hunch about what was holding this patient back from making progress; after all she was physically able to complete the task. I went home and did a little research (since then I have read a lot of research). Sure enough, I found evidence to support my hunch. Because the patient was doing the wrong thing, she was making the undesired pattern stronger.

What is Errorless Learning?

Errorless learning is a strategy or philosophy with the goal of reducing errors. We aren't trying to reduce errors for the sake of improved accuracy during therapeutic trials. We are trying to reduce errors so patients are practicing the desired information or process correctly (even if that means they need more assistance during trials). This in turn results in improved accuracy of task completion.

When you are working with a patient with dementia, it is easy to set a goal for improved accuracy (e.g. transfers, ambulation with walker etc.); however, it is much more challenging to obtain improved accuracy. Errorless learning is a well-researched dementia communication strategy.

Errorless vs. Errorful Learning

If focusing on correction of tasks isn't ideal (due to creating an errorful learning situation), then how do we get patients to complete therapy tasks in an errorless environment? The first thing we need to do is separate task-training accuracy and independence goals for patients with dementia or cognitive impairment.

An errorless learning environment relies on the patient receiving all the cues (verbal, visual, and tactile) required in order to complete tasks without error. If the goal is learning a task accurately, then we need to remove the independence aspect, until the task has been mastered.

Evidence-based dementia communication strategies, such as spaced-retrieval therapy and vanishing cues, pair nicely in facilitating an errorless learning environment. As tasks are being mastered, these strategies support our goals for patient independence.

Using dementia communication strategies may be the missing component to helping your patients achieve their goals. Co-treatment requires scheduling and extra effort, but disciplines working together have more tools to use. Collaborate with the SLP on your team to design individualized plans using dementia communication strategies, so you and your patients can meet goals even when dementia or other cognitive impairment is a factor.

Rachel Wynn, MS, CCC-SLP, is a speech-language pathologist specializing in elder care. As the owner of Gray Matter Therapy, she provides education to therapists, healthcare professionals, and families regarding dementia and elder care. She is an advocate for ethical elder care and improving workplace environments, including clinical autonomy for therapists. She is presenting at an upcoming webinar "Dementia Communication Strategies to Improve Therapy Outcomes" with Gawenda Seminars.

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An OT Goes to Atlanta
by Jon Bassett

There's an occupational therapist in Georgia who's running for a seat in the State Senate.

Bikram Mohanty, OTR/L, who owns Innovative Rehab Solutions, with two outpatient clinics in Waycross and Valdosta, Ga., is the Democratic candidate for Georgia's 8th Senate district, which encompasses six counties in the south central part of the state.

Mohanty ran in the 2012 race for District 8 and captured almost 40% of the vote. While he lost to Republican incumbent Tim Golden, Golden announced in March that he will not be running for re-election, so Mohanty is confident that he can capture the seat come November.

"I came to this country in 1995," Mohanty told me. "I had $50 in my pocket and the clothes on my back." Following his education at the National Institute of Orthopedics in Calcutta, Mohanty pursued the dream of many OTs in that country, making his way west. He settled in South Georgia, and began practicing with Aegis Therapies and then South Georgia Medical Center. In 2002, he opened his own practice, which at one point had more than 50 employees.

"This country has inspired me to reach higher," he said of his decision to open his own business. "I consider every challenge an opportunity."

If elected, Mohanty will split his time between the business and serving his constituents. State legislators must be in the capital from January through April. Mohanty ran unopposed in the Democratic primary; Republican candidate Ellis Black defeated John P. Page in a runoff primary election July 22 and will face Mohanty in November.

Mohanty decries a severe shortage of rehabilitation professionals in political positions -- which does patients a disservice, he said. It's a mission he hopes to bring to Atlanta. "Imagine having a PT, OT and a speech-language pathologist in every State house," he said. "Think what that would do for our patients. I'm running for their dream."

Mohanty uses the example of a proposed state bill that would prohibit insurance companies to halt coverage for children who have autism when they reach a certain age - a common policy among insurers. Effectively the bill -- which has passed with universal support in the Senate but is stalled in the House -- would ensure lifetime coverage for people with autism.

"OTs see autistic children all the time," said Mohanty. "Imagine what this bill could do for families, and for OT practitioners." Another example is the Medicare therapy cap. "In all practicality, think what would happen to that cap if there were more therapists in Congress. I want to reach out to every OT, PT, and speech-language pathologist and tell them this task is critical."

But Mohanty pledges to bring more than just a therapist's perspective to office. His flagship issue is education. After learning that many teachers in his district pay for school supplies out of their own pockets, Mohanty has pledged to improve school funding, and promises to accept only $1 in Senate salary, donating the rest to his district's teachers.

To accomplish his objectives, Mohanty declares he will sidestep ideological divides and work together to arrive at real solutions for his constituents.

"The principle that I go by is that political opponents can be friends," said Mohanty, alluding to the current atmosphere of deadlocked government in which innovative ideas are not allowed to flourish. "Idealism is fine, but we have to find a way to not pull each other down."

The election will be held November 4.

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Moving to a Master's?
by Jon Bassett

INDIANAPOLIS -- In December 2013, the National Athletic Trainers Association (NATA) released a white paper titled "Professional Education in Athletic Training," a 23-page document that examined the issue of moving the profession of athletic training from a bachelor's to an entry-level master's degree.

The document, the result of a work group composed of experts and representatives of the Committee on Accreditation of Athletic Training Education (CAATE), summarized that "it is the conclusion of this group that professional education in athletic training should occur at the master’s degree level."

But the document has not been met with universal acceptance among members of the profession, and the issue has been fraught with conflicting opinions. A spirited discussion titled "The Appropriate Professional Degree for the Professions of Athletic Training" was held Thursday afternoon June 26 at the Indiana Convention Center in Indianapolis in an effort to hear comments from the work group and the audience.

Lennart Johns, PhD, ATC, professor and chair of the sports medicine and athletic training department at Quinnipiac University in Connecticut, and James Scifers, DScPT, LAT, ATC, director of the School of Health Sciences at Western Carolina University in Culowhee, NC, presented a point-counterpoint session debating the findings in the white paper and the potential effects on the athletic training profession.

"We tried to objectively analyze the data" while keeping emotions out of the debate, said Johns, making the point that currently, roughly 50% of instructional hours are devoted to athletic training instruction in 4-year programs -- the rest being comprised of general education courses. Since most master's level programs are an additional two years, instructional hours devoted to athletic training principles would effectively double, should the profession make the shift to master's-level entry. 

Panel speakers and audience members in support of the move cited increased retention, elevated respect, improved patient perception, and potentially higher pay as reasons to shift to an entry-level master's. Several educational programs, such as the University of Montana (according to one member of the audience), is phasing out its undergraduate athletic training degree in favor of an entry-level master's. 

However, cost was cited by many commenters as a serious obstacle, particularly given low salaries in the profession.  Starting salaries among those with a bachelor's degree across all disciplines averages around $45,000, Scifers said, and athletic training remains below that. "We need to get our graduates to that level," he said.

Bill Prentice, PhD, ATC, PT, FNATA, professor in the department of exercise and sports science at the University of North Carolina Chapel Hill, thanked the panel members for the open dialogue and looked forward to more discussion. "It doesn't have to be us vs. them," Prentice said.

The issue is still in the discussion phase and no plans to implement the recommendations of the panel have yet been announced. 

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'The Power of the Human Spirit'
by Brian Ferrie

CHARLOTTE, NC -- Jimmy Fallon isn't down here for the APTA's 2014 NEXT Conference and Exposition, but he was about the only thing missing from the "Tonight Show"-style opening event last night. APTA CFO Rob Batarla served as master of ceremonies, with the homage including everything from a comical monologue to interview couch, succession of guests and even a house musical act, the Doug Burns Band. Fittingly the first guest was APTA President Paul A. Rockar Jr., PT, DPT, MS, who excitedly announced the "fantastic news" that Michigan had just become the 50th state with direct access. He geared additional comments toward PT students, emphasizing they can be "game changers for the profession."

New APTA CEO J. Michael Bowers then took his turn on the couch and was asked about his impression of PT professionals since taking the job in February. "I love you guys," he said with a broad smile, eliciting enthusiastic applause from the packed auditorium. When the discussion turned to APTA goals, Bowers added, "We want to be as large and strong an organization as we can be, continuing to expand our reach."

Other PT dignitaries who took the stage to offer comments on the profession included Skye Donovan, PT, PhD, OCS, program chair of the conference work group, and Cole Galloway, PT, PhD, professor and interim chair of the department of physical therapy at the University of Delaware.

But the star of the show was keynote speaker Captain Mark Kelly, an American astronaut, bestselling author and retired US Navy pilot who flew 39 combat missions during the Gulf War. Kelly's own accomplishments would have been more than enough to justify keynote status, but his presence carried even greater relevance because he's also the husband of former US Congresswoman Gabrielle Giffords. Kelly has served as Giffords' primary caregiver and most ardent supporter during her continuing recovery from a gunshot wound to the head that miraculously did not take her life at a 2011 community outreach event in Arizona.

The inspirational speaker captivated attendees with stories about his rise from troublemaking teen in New Jersey to decorated Gulf War veteran, before ultimately becoming an astronaut who made four trips into space and commanded the final mission of space shuttle Endeavour.

"I firmly believe we all learn at different rates," he said. "How good you are when you first try something isn't the only indicator of how good you can become at it."

He emphasized that life has taught him the power of having a goal, a plan to reach it and working hard toward that end. Kelly related how applicable this philosophy is to physical therapy in general and his wife's recovery in particular. The powerful presentation even included a short video of Giffords herself addressing the audience about her progress and continuing determination to overcome the effects of traumatic brain injury.

"The power of the human spirit is an incredible thing, and physical therapists get to see it every day," Kelly emotionally stated. "It's really amazing what you all do and I want to thank you for it."

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